MORPHINE and Dying Patients

Nurses General Nursing

Published

Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.

As a daughter who was with her dad in his dying moments, I am grateful the hospital staff gave him morphine to ease his gasping for breath and his pain. He went as peacefully as he could.

Contrast this with my aunt's dying from lung cancer about 10 years ago. The hospital staff did not give her enough pain-killing medicine and she died in agony.

I am glad for the current emphasis on relieving pain. Years ago there was not the same emphasis and a good friend's father dying from cancer begged his family to 'kill' him as he could not stand the pain.

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Specializes in ICU, SDU, OR, RR, Ortho, Hospice RN.

Suespet I respect your opinion but just because a patient 'looks' comfortable does not necessarily mean this.

If a patient was in pain and receiving regular pain medication before the active dying, non communicative phase, then they still have pain. Pain does not miraculously stop once they are unconscious.

Pain medication still must be given to ensure their pain is controlled as best we can.

That is what we do being their advocate and care giver. We remain one step ahead and vigilant of all we can do.

The Lord certainly knows where our hearts are and that is doing the very best we can in our comfort measures of those patients put in our care until their (we pray) comfortable death that they request.

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Specializes in LTC, office.

There is a reason end-of-life care is often referred to as "comfort care". I consider it our responsibility as the nurses caring for those patients to ensure they are as comfortable as possible. In my seven years of experience in LTC I considered it an honor to care for the dying residents. My aides and I would do all we could to help these people be comfortable and of course that included morphine; both long acting and short acting for breakthru pain.

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Specializes in LTC.
i don't agree w/ giving more morphine,just cuz all the other nurses are,when a pt. doesn't appear in any distress whatsoever(gen hospice pt's)then i know my dose ended their life,& vatican or not,i don't like interveneing in the"HIGHER PLAN"

I was the 3-11pm nurse for an LTC hospice patient with metastatic bone disease and maybe mets to the brain because she was usually only A&O x 1. I agreed with suespets and didn't give PRN morphine often, like the other nurses did. I thought if she wasn't in distress, she didn't need it. I found out on my own that by the time this lady was crying, "Help me; help me" the PRN dose didn't help. I asked about increasing the dose, but the hospice nurse said it was much harder to stop the pain once it started than to prevent it from happening in the first place. She told me to start giving the morphine every day after dinner. It worked; reduced crying on my shift, and she survived another eight months. We did increase the dose a couple of times, but by staying on top of the pain, we could use the lower dose for longer, and she was ok when her daughter came to help the patient finish eating dinner.

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Specializes in Med/Surge, Private Duty Peds.

i have not problem giving morphine to make the patient as pain free and comfortable as possible. if i have an order to give 2-4mg every 2 hours i give it.

i have also had family members ask me to give whatever i can to keep their loved one comfortable.

i have also been with families that " don't want" their loved one to become additive. i educate these people on why the morphine is used and that their loved one is not becoming additive and it helps to decrease the anxiety the pt is feeling and helps them to relax and not struggle to breath. i usually spend as much time as possible educating and usually the family comes to accept that.

also, since i work 11-7, i have come into a situation where a family is upset because their loved one has been in pain and it wasn't controlled . so i will go check the mar's and if the pt can have morphine, ativan or whatever, i inform the family and they usually respond by " please just make them comfortable, use whatever is ordered".

so no i have no problem with this, what i do have a problem is with giving these types meds to drug seekers and that is a whole other story.

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Specializes in Orthopedics/Med-Surg, LDRP.

I just had this as my first situation a few weeks ago. Family signed a DNR. She had cancer that had mets to the bone, brain, spine, ribs, sternum - everwhere basically. She had also had a stroke in ICU and was basically in a non-responsive state. She came to us with bp's of 80s/40's, resps 7, HR 110. I didn't expect her to live out my shift. She was on a morphine drip at 15ml/hr. She ended up living another week on our floor before being transferred to hospice and when she was transferred, she was at 38ml/hr. Everytime we turned her she would moan out in pain. We struggled with titrating the morphine and the family was having 2nd thoughts about the DNR and the longer she lived, the harder it was on everyone. But when she was positioned just right, when the morphine was at a theraputic level she looked peaceful and her breathing easy and unlabored. That's when the family is at peace. Sometimes it's just as much about treating the family when you're treating the patient. No family member wants to remember their dying loved one as having suffered in the end.

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i don't agree w/ giving more morphine,just cuz all the other nurses are,when a pt. doesn't appear in any distress whatsoever(gen hospice pt's)then i know my dose ended their life,& vatican or not,i don't like interveneing in the"HIGHER PLAN"

So, hospice has gotten your patients pain under control and you don't want to give their dose of pain med because you don't think they "look like" they are in pain? Remember that your not giving those doses you don't give may cause that patient to get in so much pain that it will take many hours to get the pain back in control. Where were you in school when they taught that the patients pain is what they say it is not what you think it is? Going by your theory I have a lot of patients I would not be giving pain med to because I didn't think they looked like they were in pain. Used to be that way too and we had a lot of people suffering unnecessarily.

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as i said ,"not to a pt. who is in noooooooodistress whatsoever!no vs sign prob, no crying out, no dyspnea!!!!!!!!!!!!!!you become hospice,your talking ,you walking,your eating,your in moderate pain, you get ordered ms04,abhr& u become unconsious, getting ms04 round the clock,so the family can feel closure???when did i become god, (or the devil)?btw, i work in a christian home.

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Specializes in Corrections, Cardiac, Hospice.
as i said ,"not to a pt. who is in noooooooodistress whatsoever!no vs sign prob, no crying out, no dyspnea!!!!!!!!!!!!!!you become hospice,your talking ,you walking,your eating,your in moderate pain, you get ordered ms04,abhr& u become unconsious, getting ms04 round the clock,so the family can feel closure???when did i become god, (or the devil)?btw, i work in a christian home.

Hospice patients live and function at home independently for monthes on morphine sulfate. You blame the morphine for the patient being unconsious? Not the brain cancer/lung cancer/pancreatic cancer and the dying process? I have had patients on Methadone 120mg/day up and talking. I have had patients on subq 50mg/hour of morphine, up and talking. I have also had patients on 1mg/hr of morphine in a coma. I wish the hospice program that comes to your facility would do a better job of educating the nurses about the benefits of morphine and the dying process.

Just as an FYI, When I was in labor with my son I slept at home. My vital signs when I got to the hospital were stable and I didn't C/o of horrific pain. I was 10cm dialated. My point is, when I am in pain, I shut down and I sleep. If you were to look in on me at a time like that, you would think, nope, no distress and comfortable. But guess what, it hurt like HECK.

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as i said ,"not to a pt. who is in noooooooodistress whatsoever!no vs sign prob, no crying out, no dyspnea!!!!!!!!!!!!!!you become hospice,your talking ,you walking,your eating,your in moderate pain, you get ordered ms04,abhr& u become unconsious, getting ms04 round the clock,so the family can feel closure???when did i become god, (or the devil)?btw, i work in a christian home.

hmm... it's okay suespets. They are just trying to better understand your point of view is all... no one is calling you God or a devil. You have strong Christian beliefs, I can tell, so in the sake of your Christian spirit just try to enjoy the debate and express your opinion in anyway want without bringing frustration or anger out. I agree with you that a pt., especially in LTC facilities that are given medications just to make them less "troublesome" in some respects is a shame... (not the terminally ill, but those just in hospice care who still have some "kick" in them) but, the frequency of this isn't as high as the stereotypes would make it sound to be... there are so many self-advocacy groups out there for the elderly and others in LTC type facilities... especially where the state is involved. It has nothing to do with being Christian, per se... just a decent, responsible and caring... care provider. If you are capable of living some kind of enjoyable life without any pain and still be able to function then there should be no reason for such strong pain medications... even if you are in pain and can still function and live a life at some level, you shouldn't be given so much medication that you are a zombie.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
as i said ,"not to a pt. who is in noooooooodistress whatsoever!no vs sign prob, no crying out, no dyspnea!!!!!!!!!!!!!!you become hospice,your talking ,you walking,your eating,your in moderate pain, you get ordered ms04,abhr& u become unconsious, getting ms04 round the clock,so the family can feel closure???when did i become god, (or the devil)?btw, i work in a christian home.

If the patient is a walkie talkie and able to express their pain level, one would medicate accordingly. Hospice nurses do this as well. ATC pain meds work more effectively for chronic/cancer pain than prn, so I support this. However, snowing the patient until the end under the circumstances you mention above is wrong.

(BTW, it would be an easier read with proper capitalization. sorry.)

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

It's hard being the one to give a "death dose". I medicated a patient with 10 mg of MS and she died within minutes. I didn't feel bad because the day prior she was restless and expressing horrible pain. The next day I came in, and she was comatose and in the process of dying. He BP was horribly low but her respirations were rattly and tachypnic. Knowing her pain suddlenly wasn't cured overnight, I gave her the medicine.

Did my giving her the Morphine kill her? Did the cancer kill her and I just sped it up?

I'd like to think her last breaths were comfortable and her pain was relieved and I pray some nurse does the same for me when I can't speak for myself.

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